Pathoma: Breast Cancer Flashcards
What are risk factors for breast cancer?
All of the risk factors relate to estrogen exposure:
•Gender (females have more estrogen exposure than males)
•Age (older women have been exposed to estrogen for a longer period of time than younger women)
•Early menarche and late menopause
•Obesity
What is Paget’s disease of the nipple?
DCIS that has marched up the duct and out of the nipple
Why does DCIS often calcify?
DCIS calcifies because the proliferating cells in the lumen do not have adequate blood supply and thus die.
What two non-malignant disorders can calcify?
- Sclerosing adenosis
* Fat necrosis
Describe the most common histologic type of DCIS.
The most common type is the comedo type, which presents with ducts full of calcified deposits surrounded by necrotic debris.
Describe the four subtypes of invasive ductal carcinoma.
- Tubular: forms tubules (surprise, surprise) that look like normal breast; one key difference is that tubules lack myoepithelium
- Mucinous: malignant cells floating in mucus
- Medullary: high-grade malignant cells in an inflammatory background; found more commonly in BRCA mutations
- Inflammatory: presents like acute mastitis –erythema and tenderness –but on biopsy you notice cancer withing dermal lymphatics; the blocked lymphatic drainage is what causes the swelling and erythema
Which of the four subtypes of invasive ductal carcinoma has the worst subtype?
Inflammatory, because it’s already in the lymph system
Why is LCIS often discovered incidentally?
LCIS does not produce calcifications or masses because these cells lack E-cadherin.
What is the treatment for LCIS?
LCIS is considered a risk factor for developing invasive carcinoma, so patients are given tamoxifen and followed closely for progression.
What is the classic histologic sign of invasive lobular carcinoma?
Single-file cells in a line
Explain how sentinel nodes are detected.
The breast is injected with radioactive dye and that dye is followed to the axilla. The nodes that first get that dye are the sentinel nodes.
What is the generic name for Herceptin?
Trastuzumab
Where is the estrogen receptor?
It starts out in the cytoplasm, but when it binds its partner it moves to the nucleus.
Which type of BRCA raises the risk of ovarian cancer?
BRCA1 (ONe = OvariaN)
Describe some key features of male breast cancer.
- Associated with Klinefelter and BRCA2
- Subareolar (because this is where most male breast tissue exists)
- Usually invasive ductal (because men have no lobules)
